Heterologous sera


Antilymphocyte globulin is a gammaglobulin prepared by injection of human lymphocytes into various animals (e.g. horses) and then purifying the IgG against human lymphocytes from the serum. It is used for prophylactic and curative treatment of kidney graft rejection.
 
Murin monoclonal antibodies are used against tumor antigens in oncology.
 
Incidence
Anaphylaxis is uncommon.
 
Serum sickness is more frequent.
 
Risk factors
Detection of IgE antibodies against hair from the animals providing the serum.
 
Clinical manifestations
General: anaphylactic shock, serum sickness (most common).
 
Respiratory: adult respiratory distress syndrome.
 
Renal: glomerulonephritis.
 
Cutaneous: cutaneous eruptions, periorbital edema.
 
Diagnostic methods
Skin tests must be performed before injection in order to detect IgE antibodies and ascertain the risk of anaphylactic reaction.
 
A 20-minute intervals, perform:
  • prick test at 1:10
  • intradermal injection of 0.02 ml at 1:1 000 or 1:100
  • intravenous injection of 0.5 ml at 1:10.
These tests are often positive with fresh antilymphocyte globulin, but negative if the product is left to stand for 4 to 8 hours at room temperature.
 
Mechanisms
IgE-mediated hypersensitivity underlies immediate reactions.
 
Circulating immune complexes underlie serum sickness (IgE antibodies).
 
Management
Use aged antilymphocyte globulins in patients with negative reactions to the aged products.
 
If necessary, desensitization may be performed in patients with positive skin tests, but the risk of fatal anaphylactic shock remains.
 
Start with an intravenous injection of 0.1 ml at 1:1000 and then double the dose every 15 to 20 minutes.
 
If a reaction occurs, resume treatment at half the dose that caused the reaction.
 
When 1 ml of pure serum is reached, the rest can be administered by slow infusion.
 
Serum sickness is probable between the 10 and 14th day following desensitization. Treat with corticosteroids.

References

  1. J. Gifford, "Serum therapy and immunoprophylaxis". In Altman (ed.) Clinical Allergy and Immunology, Boston G. K. Hall Co., 1984, 359–387.
  2. E. Cunningham, Y. Chi, J. Brentjens, R. Venuto, "Acute serum sickness with glomerulonephritis induced by antithymocyte globulins", Transplantation, 1987, 43, 2, 309–312.
  3. J. Gartner, H. Earl, D. Carrington, C. L. Jiang, T. Sullivan, "Reactions to anti-lymphocyteglobulin (ALG)", J. Allergy Clin. Immunol., 1987, 79 (1), 237.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.